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Debate Heats Up Over Screening Athletes for Sickle Cell Trait

Debate Heats Up Over Screening Athletes for Sickle Cell Trait

12/28/12

FRIDAY, Dec. 28 (HealthDay News) -- Though heart problems or
heatstroke generally are to blame for a young athlete's sudden
death, experts now know that carrying an aberration called the
sickle cell trait also poses substantial risk.

That has led to mandatory screening for anyone hoping to
participate in National Collegiate Athletic Association Division I
athletics. Not everyone, however, thinks that's a good idea.

Having the sickle cell trait is different from having sickle
cell disease. People with the sickle cell trait inherited a sickle
cell gene from one parent, but not both. Because they just
inherited one gene, they won't have sickle cell disease, which
develops because of abnormal red blood cells that can lead to
anemia, pain, infection, and organ damage.

In the United States, an estimated one of every 500 blacks and
one of every 36,000 Hispanics have sickle cell disease.

By contrast, one of every 12 blacks has sickle cell trait,
although most people with the trait never show signs or symptoms of
the disease, according to the U.S. Centers for Disease Control and
Prevention.

The exception to this is when a person with the sickle cell
trait becomes dehydrated and experiences low oxygen levels -- a
condition that can develop when someone who hasn't been especially
athletic suddenly participates in intense exercise, such as
military boot camp or pre-season training for athletic
competitions.

"In military personnel, they found a 30-fold increase in the risk of sudden death for people with sickle cell trait who were in boot camps," explained Dr. Robert Dimeff, medical director of sports medicine at the University of Texas Southwestern Medical Center at Dallas.

The sudden death of a college football player with the sickle
cell trait prompted the NCAA policy in 2010. Now, all Division I
athletes must have what's known as a sickle cell solubility test as
part of their routine physical examination. Players who were tested
at birth as part of newborn screening programs can opt out if they
have proof of that test. Athletes also can refuse the test, but if
they do, they must sign a liability release form.

If testing detects the sickle cell trait, the NCAA advises the
athlete's coaches and trainers to learn the symptoms of potential
trouble for someone with the trait. Recommendations include
allowing longer periods of rest and recovery, encouraging the
athlete to report any symptoms without fear of punishment,
adjusting the workout in conditions of extreme heat or high
altitude, and emphasizing hydration.

"I want my athletic trainers and coaches to know who to watch early on," Dimeff said. "It just helps to have that information. Our goal is not to exclude athletes. We want to know who has risks and how to minimize those risks. We want you to be able to play in a way that's safe."

Some don't believe, though, that mandatory screening is the best
way to accomplish this. According to the American Society of
Hematology, "screening for sickle cell trait should be voluntary
and should take place in a setting that ensures privacy and is
performed by a knowledgeable provider who is able to offer
comprehensive counseling."

"Our concern is that this is a mandatory screen in order to play," said Dr. Janis Abkowitz, the society's president-elect and head of the hematology division at the University of Washington in Seattle. "If a player refuses the screen, they have to sign off on a liability waiver, and there's a lot of inconsistency in these waivers from college to college."

And, the fact that the policy is mandatory, she said, has led to
some misunderstandings.

"The policy gives a false impression that sickle cell trait is what really counts in these sudden deaths because that's what's screened for," but other conditions can cause sudden death, Abkowitz said.

The top four causes of non-traumatic sports death, in order of
occurrence, according to the National Athletic Trainers
Association, are heart conditions, heatstroke, sickle cell trait
complications and asthma.

Abkowitz also pointed out that the NCAA policy has some
unintended consequences. "Some people with sickle cell trait have
misunderstood the screening policy and think they can't participate
in exercise," she said. "But, regular exercise in a normal form is
good and healthy."

A better solution would be to "implement preventive measures
that would protect all athletes," she said.

Abkowitz noted that even the U.S. Army has stopped mandatory
screening for the sickle cell trait. Instead, they monitor all new
recruits undergoing vigorous training for heat illness, adjust the
work-rest schedule to the environment and have implemented
guidelines for staying well hydrated. And, Army personnel are now
trained in recognizing and treating heat illness.

"Our hope is that the NCAA will consider our concerns, note the unintended consequences of their policy and see this as an opportunity to implement preventive measures that would protect all athletes, making universal screening unnecessary," Abkowitz said.

More information

The U.S. Centers for Disease Control and Prevention has more
about
sickle cell trait.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.